Good for recruitment, better for retention, mandatory for your survival.

A decade ago, “Community Service Riders”(CSRs) were a very common component of clinician compensation formulae, then they disappeared. 
 
These riders were part of the “bonus” calculation.  Perform a public service and the clinician qualified for additional compensation.  A charitable board member, a food pantry volunteer---these were some of the services that counted.
 
These riders began to disappear at about the same time older clinicians began to be absorbed into the workforce through merger and acquisition.  The transition to assembly line medical care probably finished the job.
 
Well, your organization needs to bring them back---right now.
 
Why?

Got your attention?  Read on.
The young clinicians graduating today have been brought up on individualism, with a mission to personally “making a dent in the world.”  More connected than ever, they recognize their privileged position and feel that they must give back.
 
I know, I been working with them on their employment contracts for years now.
 
They expect work with meaning.  They’re starving for it.
 
A CSR on your employment contract will give it to them---and suggest to them that you’re an organization that walks the walk---an organization that they can brag about being a part of.
 
Such riders a key characteristic that I focus on as I advise young clinicians on their compensation.
 
But these riders do more than that.
 
They’re essential, absolutely essential for your Medicare Advantage success.
 
CMS is gradually altering its formula for calculating RAFs. The underserved, the impoverished, the disabled, CMS is diverting more resources their way---at the expense of other, more traditional beneficiaries.
 
So, if you don’t make an effort to recruit these types of patients, you’re going to get paid less for doing the same work.
 
And to help you attract those patients, Congress has made the Special Needs Plans (SNPs) initiative permanent, giving insurers the visibility to create coverage plans tailored to the underserved.
 
Some of the resulting SNPs are truly awesome.
 
And how are you going to recruit these patients?  How are you going to attract them to your organization and your primes?
 
Use Community Service Riders to encourage your young primes to do what I did---go bowling.
 
More than half of my patient panel was made up of “dual-eligibles” who picked me as their PCP because we bowled together in a late-night league.
So, pay your clinicians to go out into the community during their first contract.  Have them interact with underserved patients as respected peers. The rest will take care of itself.
 
Your service-oriented primes are hungry for meaning. The underserved patients are hungry for access and respect.
 
It’ll be like a chemical reaction.  Get both of them in the same space and POW---instant value.
Or you could just make less money doing the same thing.
 
You should know
 
Therapy Caps Lifted---A Big, Big Threat to your Medicare Advantage Performance
 
You’ve just been blindsided by a greatly under-appreciated threat to your profitability.  The 2018 two-year budget agreement effectively lifted the blanket hard cap on therapy services.  There are some new administrative hoops therapists will need to jump through, but the upshot is a repeal of the $2,000 to $3,000 limit that a beneficiary can spend on therapy services each year.
 
Medicare Advantage patients will still need a referral to get treatment, but there will be no practical limit on the amount of services the therapists can encourage their patients to receive.
 
Great summaries from the therapy point of view can be found here and here.
 
If you don’t take steps now, its gonna cost you big.
 
How do I know?  I’ve been there
 
Therapy services have only been really capped for a little more than a decade.  Before then, they were an enormous drain on my Medicare Advantage pool.  There were few things that were more work and less rewarding than fending off therapy providers as they trolled for patients.
 
In nursing homes, through “free” seminars, via direct marketing---they were relentless.
 
And with each request for services, I had to explain to the patient why therapy might not be appropriate.
 
The only leverage I had was our relationship and their co-pays.
 
Fortunately, my insurer listened to us and increased those patient co-pays to create more of a disincentive to excessive utilization. 
 
Eventually, I developed collaborative relationships with my favorite therapists.  They knew they had to take exceptional care of my patients.  They also knew that if they stepped over the line and churned my patients for a few extra bucks, they would never see another patient of mine again.
 
It took several years, but these tactics finally paid off. My patients received good care and I received professional service.
 
But even then, dealing with therapy service requests were still a real pain.
 
Then hard caps on coverage were enacted.  Yearly limits on therapy payments.  And the therapy providers no longer had the financial resources to troll.
 
You wouldn’t believe how fast my therapy costs dropped the first year after these hard caps were enacted. It was a godsend to my overall performance.
 
Well, now the hard caps are gone. And you can bet the same venture capitalists who have been buying up hospices and other costs centers are now homing in on therapy providers.
 
Look for them to absolutely suck you dry.  Unless you take steps right now.
If you don’t risk-share with your primes, if they don’t have skin in the game---just accept your losses.  Any utilization-control systems you put in place are going to alienate your patients and cost as much as you save.  Your best bet in this case is to deal with the problem at the contract level by narrowing your therapy provider network and internalizing your costs.
 
These are not ideal solutions, and they’ll come with significant costs in labor and beneficiary satisfaction.  But in the absence of risk-sharing, they’re the best options you have.
 
But if you do risk share---let your primes know about the repeal of therapy caps NOW!
 
That way they can begin to educate the patients and blunt the effects of the therapist’s outreach attempts that are sure to come.  They can also begin to develop the same relationships with their therapists that I did and make their expectations known.
 
I have no idea why the loss of therapy caps is not getting the play in the professional press it deserves.
 
It’s a real threat to high-performing Medicare Advantage plans and the clinicians who risk-share.
 
And for the marginal plans, the threat is existential.
Copyright © 2018 Tom Davis Consulting, All rights reserved.


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